Provider Demographics
NPI:1972622330
Name:HOGAN, MICHAEL (DC, DACBSP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HOGAN
Suffix:
Gender:M
Credentials:DC, DACBSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2915
Mailing Address - Country:US
Mailing Address - Phone:425-610-3796
Mailing Address - Fax:425-610-3803
Practice Address - Street 1:2519 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2915
Practice Address - Country:US
Practice Address - Phone:425-610-3796
Practice Address - Fax:425-610-3803
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034038111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU87984Medicare UPIN
WAU87984Medicare UPIN